If you have OCD and you’re looking for help, you may be wondering whether exposure and response prevention (ERP) really works over video. It’s a fair question. ERP asks you to face your fears on purpose, and it’s natural to wonder whether that can happen through a screen. The short answer is yes. The research is encouraging, and here is what it shows, along with what it can’t tell us.
Why this question matters
ERP is the first line treatment for OCD, but it can be hard to find. Therapists with real ERP training are scarce, and many people live far from one or can’t fit weekly office visits into their lives. Video therapy opens that door. For some subtypes, it lets a therapist work with you where OCD actually shows up, like your kitchen, your car, or your bathroom, instead of trying to recreate those moments in an office.
The largest study
The biggest study of online ERP to date was published in 2022 in the Journal of Medical Internet Research. Researchers at NOCD, a large telehealth provider for OCD, reviewed the records of 3,552 adults with a primary OCD diagnosis who were treated between January 2020 and June 2021. The authors describe it as the largest group of treated OCD patients ever reported.
How treatment worked.
Clients had twice weekly 60 minute video sessions for three weeks, followed by six weeks of weekly 30 minute check-ins. Between sessions they could message their therapist and use an app to build exposure plans. Therapists were licensed at the master’s or doctoral level and trained in ERP by NOCD.
How results were measured.
Clients completed a standard self report OCD questionnaire (the DOCS) before treatment, at the midpoint, and at the end. Follow-up questionnaires were sent at 3, 6, 9, and 12 months.
What they found:
- OCD symptoms dropped by 43.4% on average, which is considered a large effect.
- 62.9% were full responders, meaning their symptoms fell by at least 35%. Counting partial responders, the number rose to 74.2%.
- Depression, anxiety, and stress improved too, by roughly 44%, 48%, and 37%. Quality of life improved by about 23%.
- Results were similar for people with mild, moderate, and severe OCD.
- Treatment took about 11.5 weeks and about 10.6 hours of therapist time. The authors note that standard once weekly ERP often takes more than 25 hours.
- Gains held at the 3, 6, 9, and 12 month check-ins among the 46% of clients who completed follow-up.
The authors point out that the size of the improvement is close to what controlled trials of in-person ERP have found.
The fine print. This was a retrospective study with no comparison group, so it can’t prove that video is equal to in-person care. The authors work for or are paid by NOCD. Outcomes were self reported, and most people rated as extremely severe were referred to a higher level of care rather than treated, so we know less about that group. Still, a group this large, treated in everyday conditions rather than a tightly controlled trial, tells us a lot about how video ERP works in the real world.
Kids and teens
The same team followed up in 2025 with 2,173 children and teens, ages 4 to 17, treated by video with parents involved. This is the largest study of its kind in young people. At about four months, symptoms had dropped by a median of 38.5%, and 54% were full responders. Gains were maintained or improved at follow-up out to about a year, and results were similar for children and teens, and across mild, moderate, and severe OCD. Improvement was a bit smaller than in adults, which the authors suggest may reflect how hard it is for young people to grasp why facing fears helps. The same caveats apply.
Other studies worth knowing
There are few head to head studies, but the picture is consistent.
- A randomized trial from Japan (2024). Researchers assigned 199 adults with depression, anxiety, or OCD to care that was mostly by video (at least half of visits) or entirely in person for 24 weeks. Video care was not inferior on quality of life, and there were no significant differences on the disorder specific rating scales. Note that this tested usual psychiatric care, not ERP specifically, and OCD was one of three conditions.
- A meta-analysis (2023). This review pooled 22 randomized trials with 1,796 participants, in adults and young people. Remote CBT with ERP worked much better than control conditions and was not significantly different from in-person treatment. Most of these trials used phone or internet programs rather than live video, so it supports remote delivery in general.
- Telephone trials (2006 and 2014). Two randomized trials, one in adults and one in adolescents, found that CBT by phone was not inferior to face to face CBT for OCD. If a phone call can work, live video with a trained therapist is a reasonable step up.
- A small pilot (2018). Thirty adults in Japan received CBT by live video, including people with OCD. Symptoms improved, and most said they preferred video to face to face.
The bottom line
No study has shown that video ERP works worse than in-person ERP, and the strongest evidence we have suggests the results are comparable. The largest numbers come from real clinical practice rather than controlled trials, so I’d call the evidence strong and still growing, not final.
What matters most is not the room you’re sitting in. It’s whether your therapist is truly trained in ERP, whether you can commit to the exposures between sessions, and whether the fit feels right. For people with very severe OCD, a higher level of care may still be the right starting point, and that’s a conversation worth having with a specialist.
If you’re looking for ERP for OCD or an anxiety related disorder and you live in California, Florida, or Idaho, I’d be glad to talk. You can reach me at sbocd.com.
Debra Dalton Stein, LMFT, Santa Barbara OCD and Anxiety
References
1 Feusner JD, Farrell NR, Kreyling J, McGrath PB, Rhode A, Faneuff T, Lonsway S, Mohideen R, Jurich JE, Trusky L, Smith SM. Online video teletherapy treatment of obsessive-compulsive disorder using exposure and response prevention: clinical outcomes from a retrospective longitudinal observational study. J Med Internet Res. 2022;24(5):e36431. doi:10.2196/36431
2 Feusner JD, Farrell NR, Nunez M, Lume N, MacDonald CW, McGrath PB, Trusky L, Smith S, Rhode A. Effectiveness of video teletherapy in treating obsessive-compulsive disorder in children and adolescents with exposure and response prevention: retrospective longitudinal observational study. J Med Internet Res. 2025;27:e66715. doi:10.2196/66715
3 Kishimoto T, Kinoshita S, Kitazawa M, et al; J-PROTECT collaborators. Live two-way video versus face-to-face treatment for depression, anxiety, and obsessive-compulsive disorder: a 24-week randomized controlled trial. Psychiatry Clin Neurosci. 2024;78(4). doi:10.1111/pcn.13618
4 Salazar de Pablo G, Pascual-Sanchez A, Panchal U, Clark B, Krebs G. Efficacy of remotely-delivered cognitive behavioural therapy for obsessive-compulsive disorder: an updated meta-analysis of randomised controlled trials. J Affect Disord. 2023;322. doi:10.1016/j.jad.2022.11.007
5 Lovell K, Cox D, Haddock G, et al. Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. BMJ. 2006;333(7574):883. doi:10.1136/bmj.38940.355602.80
6 Turner CM, Mataix-Cols D, Lovell K, et al. Telephone cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a randomized controlled non-inferiority trial. J Am Acad Child Adolesc Psychiatry. 2014;53(12). doi:10.1016/j.jaac.2014.09.012
7 Matsumoto K, Sutoh C, Asano K, et al. Internet-based cognitive behavioral therapy with real-time therapist support via videoconference for patients with obsessive-compulsive disorder, panic disorder, and social anxiety disorder: pilot single-arm trial. J Med Internet Res. 2018;20(12):e12091. doi:10.2196/12091